Growth arrest: leg length correction through temporary epiphysiodesis with a novel rigid staple (RigidTack)

Abstract

Aims Temporary epiphysiodesis (ED) is commonly applied in children and adolescents to treat leg length discrepancies (LLDs) and tall stature. Traditional Blount staples or modern two-hole plates are used in clinical practice. However, they require accurate planning, precise surgical techniques, and attentive follow-up to achieve the desired outcome without complications. This study reports the results of ED using a novel rigid staple (RigidTack) incorporating safety, as well as technical and procedural success according to the idea, development, evaluation, assessment, long-term (IDEAL) study framework. Methods A cohort of 56 patients, including 45 unilateral EDs for LLD and 11 bilateral EDs for tall stature, were prospectively analyzed. ED was performed with 222 rigid staples with a mean follow-up of 24.4 months (8 to 49). Patients with a predicted LLD of ≥ 2 cm at skeletal maturity were included. Mean age at surgery was 12.1 years (8 to 14). Correction and complication rates including implant-associated problems, and secondary deformities as well as perioperative parameters, were recorded (IDEAL stage 2a). These results were compared to historical cohorts treated for correction of LLD with two-hole plates or Blount staples. Results The mean LLD was reduced from 25.2 mm (15 to 45) before surgery to 9.3 mm (6 to 25) at skeletal maturity. Implant-associated complications occurred in 4/56 treatments (7%), and secondary frontal plane deformities were detected in 5/45 legs (11%) of the LLD cohort. Including tall stature patients, the rate increased to 12/67 legs (18%). Sagittal plane deformities were observed during 1/45 LLD treatments (2%). Compared to two-hole plates and Blount staples, similar correction rates were observed in all devices. Lower rates of frontal and sagittal plane deformities were observed using rigid staples. Conclusion Treatment of LLD using novel rigid staples appears a feasible and promising strategy. Secondary frontal and sagittal plane deformities remain a potential complication, although the rate seems to be lower in patients treated with rigid staples. Further comparative studies are needed to investigate this issue. Cite this article: Bone Joint J 2021;103-B(8):1428–1437.

Tension-band Plating for Leg-length Discrepancy Correction

“…Blount staples), no difference in correction rate or residual LLD is reported. 8 When rigid staples are used in LLD correction, concerns have been raised regarding the reversibility of the epiphysiodesis. Potentially, a complete growth arrest is induced due to the rigid physeal compression.…”

Design of a New “U”‐shaped Staple and Its Clinical Application in Postoperative Ankle Valgus of Congenital Pseudarthrosis of the Tibia in Children

“…Compared with the tension screw without tooth lines, it effectively reduces the risk of screw withdrawal. According to the literature, the probability of internal fixation loosening and migration of Blount stapler is about 9.7%–14.6% 27,28 . We used the new “U”‐shaped staple to treat 33 children without internal fixation loosening, which indicates that the risk of internal fixation failure of the “U”‐shaped staple is relatively low.…”

“…According to the literature, the probability of internal fixation loosening and migration of Blount stapler is about 9.7%–14.6%. 27 , 28 We used the new “U”‐shaped staple to treat 33 children without internal fixation loosening, which indicates that the risk of internal fixation failure of the “U”‐shaped staple is relatively low. In addition, based on the anatomical characteristics of the medial malleolus of the distal tibia, a special angle was introduced, temporarily named “the included angle between the medial cortical bone of the distal tibia and the epiphysis,” that is the included angle between the epiphysis axis of the distal tibia and the medial cortical bone.…”

Preliminary results of two novel devices for epiphysiodesis in the reduction of excessive predicted final height in tall stature

“…This procedure may also improve body proportions in patients presenting disproportionally increased leg lengths [10]. Epiphysiodesis can either be performed temporarily (tED) by reversible growth inhibition through devices bridging the physis, or permanently (pED) through definite physeal ablation [10,11]. Various devices for tED have been established, with varying success and complication rates [12][13][14].…”

“…Various devices for tED have been established, with varying success and complication rates [12][13][14]. Recently, a novel rigid staple for tED (RigidTack ™ , Merete, Berlin, Germany) has been introduced which combines the advantages of staples and plates [11,15]. pED has historically been conducted according to the techniques originally described by Phemister [16] and Bowen [17].…”